Please copy to an E-mail, complete the following information
and E-mail to BVPA Secretariat:
:
Personal Information Name and Address Membership Category Full/Associate (Delete 1)
:__ BVA Membership No. __ (if applicable) ___ Preferred first name: __ ___ Telephone _ Fax_ ___ E.Mail __ _________________Post Code:___ Year Qualified (if vet): ___
For Applicants for Associate Membership only:
Proposer (BVPA Full/ Associate Member) ____________ __/__/___
BLOCK CAPITALS Signature Date
Seconder (BVPA Full/Associate Member) __________ __/__/___
BLOCK CAPITALS Signature Date
ALL APPLICANTS: How would you describe your main activity ?: General Practice |_| Private Practice |_| Poultry Company Vet |_| Teaching |_| Research |_| Pharmaceutical Industry |_| Feed Industry |_| Other _ Please rank the following subject areas in order of their interest to you (as few/many as you wish) Genetics |_| Immunology |_| Incubation |_| Food Hygiene |_| Microbiology |_| Medicines |_| Nutrition |_| Pathology |_| Management |_| Physiology |_| Reproduction |_| Serology |_| Welfare |_| ________ |_| ___________ |_| ________ Please rank the following species with respect to your degree of interest : Cage Birds |_| Chickens |_| Ducks/Geese |_| Ratites |_| Pigeons |_| Raptors |_| Turkeys |_| _________ |_|
PLEASE NOTE: Applications for full membership (i.e. BVA members) are usually processed promptly. All other applications need to be considered at a Committee Meetings. These meetings are usually held in March and November